Baroness Hooper: My Lords, that is very good news because, given the importance of Latin America to the world economy and our historic links with virtually every country in Latin America, distressing rumours were flying around that this post would remain vacant, or that the former incumbent would not be replaced. Will the Minister further reassure us by saying that both he and the DTI will in future attempt to co-ordinate their policies and use this useful geographical post to pursue them.

Lord Triesman: My Lords, I am happy to ensure that everyone knows who is doing what so that they can get in touch with the appropriate people. I genuinely have confidence in the arrangements that we have made. We have appointed someone with considerable experience of both Latin America and the Caribbean Department. There will be a strong team of experts in London and, of course, in our posts in the area, many of which are headed at a very senior level. We would have not accepted—I certainly would not have done so—a set of arrangements in which we could not be confident. That would have been a foolish step on my part. I am confident in this arrangement, and I hope that that confidence at least conveys itself to the House.

Lord Avebury: My Lords, notwithstanding what the noble Lord, Lord Beaumont of Whitley, has said about the position of the hereditary nobles in Tonga, is he aware that proposals have now been approved by the parliament, at the instigation of Prince Tu'ipelehake, one of the leading proponents of reform, to establish a constitutional reform committee among whose general items will be the replacement of the heredity peers by an elected element? Will the noble Lord therefore consider favourably any representations that may be received from Tonga, either directly or through the Commonwealth Secretariat, for constitutional advice or financial assistance in the process of the constitutional reform on which it is about to embark?

The Lord Bishop of Rochester: My Lords, in view of the strong commitment from these Benches to inclusive admission policies for Church of England schools, will the Minister give the Government's position on interviews prior to admission.

Baroness Neuberger: My Lords, in many ways we must all welcome the NHS Redress Bill. I need to declare a few interests: I was formerly—a long time ago—chair of the Patients Association; I have been a member of the GMC and I have chaired an NHS trust, so I have dealt with some of those issues over a long period of time. Indeed, going back nearly 20 years, AvMA—Action against Medical Accidents, or the Association for Victims of Medical Accidents, as it was then called—had as its chief executive Arnold Simanowitz, who was even then proposing a similar scheme so that we could get away from the adversarial and litigious system that he saw growing in our country.
	More recently we have seen concern about the huge cost of litigation, although that is mostly down to lawyers' costs, and some very large settlements, because the actual number of cases has begun to go down. Most of us would also have broadly welcomed the Chief Medical Officer Sir Liam Donaldson's excellent consultation document, Making Amends, which came out some two years ago. No one thinks that the present system is satisfactory and all of us have concerns that it militates against a culture of openness and frankness between clinicians and patients and between staff more generally and patients. At present it leads to a less than frank approach; and given the understandable reluctance to admit mistakes it is all the more difficult to learn from them.
	If we add to that a growing risk aversion more generally in our society and a failure to accept that things will go wrong in human interactions and that modern medicine is complex and can be dangerous, we seem to have a recipe for a difficult atmosphere between patients and clinicians when things go wrong. Indeed, in my experience staff often prefer to hide mistakes because they are frightened of being blamed within their own organisations for mistakes that have taken place—as they will in normal human interactions.
	Add to that the natural if not wholly acceptable tendency of organisations to be loyal to themselves and staff within them to each other and one can see how it might be difficult for an ordinary patient or patient's relative to obtain a proper explanation or apology when things go wrong—as they do. As an NHS trust chairman in the 1990s I certainly saw that at first hand: people seemed to find great difficulty in admitting mistakes, apologising and explaining what had happened. So all credit to the Government for trying to take on the issue and for realising that the present position is far from satisfactory.
	That having been said, however, like the noble Earl, Lord Howe, we on these Benches feel that the Bill begs more questions than it answers. The Minister will no doubt already have had presented to him by other means many of the issues that I and other noble Lords will raise with him today. He may indeed answer that all our concerns will be dealt with in the detail of regulations, but I have to say that we will not be satisfied with that, any more than the noble Earl, Lord Howe, is satisfied that we have not at least seen draft regulations to examine at this stage. We too think that there may be a large number of probing amendments in Committee.
	However, we are seriously concerned with three separate aspects of the Bill as well as wishing to raise other questions. Like the noble Earl, Lord Howe, we were surprised to see that we have before us a wholly talk-based system, given all the publicity there has been about the system and all the agonising there has been about a talk-based system in the past. The first of our three major concerns, as AvMA and others have rightly pointed out, is that it is essential that any investigation into an adverse incident is truly independent. That is because of the organisational point to which I referred earlier, where those within an organisation, however well intentioned, tend to back their colleagues unless the circumstances are extreme. That is backed up by this week's news from the Healthcare Commission that around one third of NHS complaints are referred back to the organisations concerned. We are not good at dealing with that issue.
	It is also essential that the system has an independent element if the new system is to be one from which doctors, nurses and other health professionals can learn. Only by being held up to an independent view can people truly learn, where there is no question of bias.
	Yet the Bill does not say anything about that. AvMA suggests that the responsibility for investigating and deciding upon cases under the redress scheme should rest with an independent body rather than the NHS litigation authority, which is part of the NHS system and which will administer the scheme. That has some attraction, as has its suggestion that the Healthcare Commission would be an obvious candidate, given its role at the independent stage of NHS complaints. The Healthcare Commission also has a much more general monitoring role, so that it could ensure that lessons were properly learnt and absorbed from the incidents dealt with by the redress scheme.
	Even if the Government do not want to go that far, they should certainly be emulating in the Bill what has already happened in the current Welsh speedy resolution scheme and in the Resolve pilot scheme which took place a couple of years ago, a fast-track resolution scheme for smaller claims. In both schemes, the judgment as to whether compensation should be awarded was made by an independent medical expert, agreed by the NHS and the claimant together. Independence is the first main question. We would also like to know why AvMA and other members of the Clinical Disputes Forum were told that the redress scheme would be run like the Resolve and Welsh schemes, and why that now appears not to be the case.
	Secondly, there is the major question of the dropping of the duty of candour, which was such a key feature of Sir Liam Donaldson's consultation paper. Yet at least half the thinking behind the desire to go for a redress scheme such as this was to encourage openness and candour, as the National Patient Safety Agency's policy seems to suggest, as the GMC's good medical practice guidelines insist, and it has also been warmly welcomed by the Healthcare Commission. Yet that duty of candour is not mentioned in the Bill, despite it being key to the National Patient Safety Agency's thinking and despite the fact that this whole approach rests upon a desire to move away from an adversarial and less than frank approach to an open one of trust between clinician and patient where redress, when things have gone wrong, can be swift and simple.
	Thirdly—and this point has already been raised by the noble Earl, Lord Howe, and the Minister himself—the scheme appears to be limited to hospital care, despite signals from the Minister that it may eventually be extended. Yet it is clear that the vast bulk of care is provided by primary care. At present, if patients are damaged by negligence in primary care, they have to sue their GPs individually, as contractors to the NHS. That makes no sense, given the changing shape of primary care, the vast increase in care in the community, especially for chronic conditions, and it makes it difficult for both patients and GPs. Patients often know and like their GP, yet they may have been damaged by care received within the primary care system. Meanwhile, GPs are paying large premiums for indemnity cover. It is hardly satisfactory.
	There are many more questions, perhaps not of such great importance, that the Minister may be able to clarify in his response. First, what happens when it is not a case of individual negligence but system failure, arguably organisational negligence? Will the scheme cover that, and will the NHS be able to learn from it thereby? Secondly, are there any rights of appeal against a decision of the litigation authority, or does a dissatisfied claimant simply have to go to the courts, as now? If that is the case, will it not militate against openness in the system? Thirdly, who will monitor the scheme to see that it is carried out fairly—if the NHS is investigating itself—and that the NHS learns from these errors and that systems are put in place to help NHS organisations learn openly from things that go wrong? Fourthly, how will claimants be advised? Will they be able to get access to independent specialist representation and paid for beyond the solicitor who will be paid for at the time that an offer is made by the litigation authority? If not, how will this be seen as truly involving the patient as an equal, especially if the investigation is being carried out by the organisation which has been challenged and complained against?
	Few patients have the expertise to ask the right questions at the right time. Nor would they necessarily understand how judgments are made, such as by the Bolam test where it is not the "highest expert skill" that is the test but the standard of the "ordinary skilled man". One has to be technically reasonably competent to get one's head around that.
	Fifthly, although the Government have not gone for a no-fault compensation scheme—a system favoured by these Benches—the Scottish experience with the Macfarlane trust for HIV-infected people from blood products is one where people receiving payments waived their right to litigate and the Government were excluded from liability. Did the Government consider the advantages in terms of openness and less defensive practice—a contrast with the US-style practice about which the Chief Medical Officer is so worried of a no-fault system? And, if they did, and rejected it, how does the Minister think that this system will truly promote openness, when practitioners will still be concerned about being found negligent?
	How does this present Bill relate to the Swedish no-fault system, where successful claims are those that compensate for injuries unexpected by the patient and unforeseeable or impossible for physicians to avoid—in other words, the practitioner is not found to be at fault, but injuries worthy of compensation are compensated? There appears to be no similar provision in this Bill. Such a provision would give clinicians some comfort—they would not be seen to be negligent.
	Lastly, this Bill seeks to deal with relatively small claims and the Secretary of State can cap the amounts, yet the real cost of settlements comes from severely damaged babies at birth and from legal costs. To what extent will capped settlements mean that prospective claimants will choose not to use the scheme, but instead go to claims farmers operating on contingency fees? Even if legal aid will not be freely available—clearly it will not be—will a low cap not make it likely that lawyers will operate on a contingency fee basis and claimants go through the courts as at present so that the hoped-for reduction in litigation will not necessarily take place, health professionals' fears of litigation will not be reduced and the whole aim of openness and learning from mistakes will simply not be realised because the cap may be set too low?
	In conclusion, in principle we are delighted to see this legislation. But at present there are too many unanswered questions—I have given the Minister a few—and too many concerns of principle for people on these Benches to give it their unqualified support. Like the noble Earl, Lord Howe, we also think that this is a wasted opportunity.

Baroness Finlay of Llandaff: My Lords, the Bill is an important step forward in ensuring that there is reasonable compensation for patients when things go wrong. That is the point upon which I want to focus—when things go wrong.
	The Minister, in his helpful opening remarks, spoke of the framework powers for Wales. I hope that consideration will be given in negotiations on the way in which the Bill will work in practice in England towards negotiating and discussing with Wales as well. There are patients who cross the border. Cross-boundary flows are the one area where patients may get caught, because clinical conditions are very complex. It may be difficult to know to which side of the England/Wales border the error might be ascribed and blame apportioned.
	Access to the scheme depends on a tort that would be otherwise actionable. How do we know when things go wrong, however? Currently, in courts, the Bolam test is applied, to ask whether the treatment was in acceptance and accordance with current medical practice. The answer this question, there is a peer review process—from someone with the scientific knowledge and clinical expertise to give truly informed comment—and a judgment made. We are all aware of some notable failings of the expert witness system. They have been principally in relation to criminal conviction, however. It is a real problem for any system of review to know just what should, or should not, have been done.
	Medicine is now so specialised that without reference to expert opinion consistency of outcome will not be achieved. Indeed, the very foundation on which a judgment is made will be flawed. It will not be possible to have expertise in all the details of all the conditions. Some of them will be absolutely crucial to the case in hand, details which will prove or disprove negligent care. Without sound information, my concern is that inappropriate and inconsistent payments will be made. While the intention behind the Bill is excellent, it may stack up some problems if we abandon the Bolam test.
	The Bill anticipates that the Bolam test will remain. I hope the Minister will be able to reassure me on that. It would be better if the Bill explicitly stated that the redress scheme will apply only where it can be shown that the care is inadequate as judged by accepted medical practice. We are not talking about the lowest common denominator, but about a standard which is accepted as good.
	A different robust standard to the Bolam principle has not been found. Unless we use the Bolam principle, what will happen? There is, of course, a risk that people will claim that things should have been done based on anecdote, Internet website findings or whatever, but that those interventions which they claim should have happened would not be recognised as evidence-based clinical practice.
	The difficulty is that, when we look at evidence-based practice, most of the time we are looking not only at the situation of one disease and one intervention but also at complex human beings with multiple pathology and different psychological states, all of which can affect outcome. How all those interact will determine ultimately whether care was reasonable and up to standard or whether it was substandard.
	Under the NHS redress scheme, there will be inherent criticism of the NHS professionals involved in the award of a payment. If a payment is made because the care is unsatisfactory, the system must have failed—it may have been the team, a managerial system or a central policy rather than an individual.
	The claimant lobby may be trying to find another standard. It is in their interest to get the maximum compensation out of the system, and it is right that they should keep up the pressure for it. But if the compensation threshold is lower, it will be set by a person's unrealistic expectations to fly in the face of what the NHS can offer rather than realistic expectations that take into account co-morbidity and other incidental factors.
	Co-morbidity is the most important factor in determining poor outcomes, yet sadly it is rarely recognised by the claimant. Clinicians cannot be held responsible for the presence of co-morbidity before patients presented themselves but they must take it into account. They cannot always predict its detrimental effect. The difficulty in clinical practice is that doing nothing can have adverse consequences and may be more dangerous than attempting to do something, so each clinical decision is taken on a balance of risks. When those risks are finely balanced, the inexact science of human disease behaviour can tip the scales so easily the wrong way. Why do some people resist infection yet others succumb? The NHS cannot be held responsible for the inherent genetic factors in the spectrum of the "normal population". Such variation in the "normal" is not clinical negligence.
	What happens if the service is unusually stretched for some reason? In a major incident, for example, the staff and the system have to deal with that incident so other patients may have their care delivered differently. If the incident goes on for some time, some patients may get less effective care than they otherwise would—for example, a delay in diagnosis—but that must be taken into consideration in a fair scheme of redress.
	What of the difficult presentation of a serious situation? Let us take subarachnoid haemorrhage as an example. A patient has a warning bleed and attends accident and emergency with a terrible headache. A full history is taken, the patient is properly examined and is told that she has migraine because the story fits that diagnosis. She appears to recover and goes home but then has a catastrophic bleed. Not every patient who presents with a headache can have a head scan. If the patient had not recovered in the interim or the symptoms had not fitted a migraine picture, further investigation would have been indicated and warranted. Using the "stands to reason" argument, it would be suggested that the diagnosis should have been earlier and that there may not have been sufficient information to warrant such a rapid diagnosis of migraine. But when a typical situation is presented, you can see how that diagnosis was assumed and made.
	The redress scheme may award compensation, but without a robust determination of the facts the scheme risks handing out money as sympathy rather than true redress. It is usually not the NHS's fault that someone is ill or that someone's disease does not respond to treatment, and the nature of disease and its course is not an exact science—as a clinician, I dearly wish it were. But it is appropriate that, using the Bolam test, every patient should have the best possible treatment within the resources available.
	The NHS system cannot investigate every possibility of every case, but I hope the system will operate reasonably against an accepted standard, and I urge the Minister to use the Bolam principle.

Lord Parekh: My Lords, I welcome this long overdue NHS Redress Bill, whose advantages seem to me to be obvious. It reduces legal costs. In 2004–05, the cost of clinical negligence was about £503 million, of which £150 million—just under a third—went on legal costs. The smaller the claim, the larger was the percentage of legal costs.
	The Bill should also avoid complicated complaints procedures, which on average take about a year and a half, and sometimes go on as long as 10 years. It should also provide access to medical justice. Last year, I am told, around 800,000 adverse events relating to the NHS occurred. Only a tiny percentage—about 6,000 complaints—involved litigation and compensation payments. This seems to suggest that a large number of people who have suffered from medical negligence are deterred from complaining for all kinds of reasons, and the proposed scheme should be able to remove some of these.
	I like the idea that the scheme is proactive, and the onus is no longer on the patient. This should be of particular help to the poor and ethnic minorities, who are not familiar with the system of complaint and litigation that may be available to them and therefore do not take advantage of it.
	While I endorse the Bill for these and other reasons, I have a few questions. Some are straightforward and simple, others a little more complex. First, I am not clear whether the figure of £20,000 includes remedial treatment. If it does, compensation is likely to be very little and the limit needs to be raised. Secondly, how do we ensure that the remedial treatment is adequate and suitably monitored? Thirdly, this Bill would cover only a small percentage of claims. I am told that last year only 5 per cent of the claims involved amounts of around £20,000. It would therefore be useful to monitor the scheme to see how it works, and, if it works well, to find ways of extending it to claims involving larger amounts of money.
	I have difficulty with the NHS Litigation Authority. The noble Earl, Lord Howe, and the noble Baroness, Lady Neuberger, raised this question, and I want to repeat the point they made. I am not entirely sure that the authority can be both prosecutor and judge. It is bound to be seen as in some sense loaded in favour of the medical staff against whom the complaint is made. We must find some way of ensuring that the two functions are separated. I am also not entirely sure how the authority is to be composed. Will it include a larger percentage of lay members than it has so far? What about ethnic minorities?
	My next point concerns the mechanism to ensure that information on mistakes made in one hospital or NHS trust is circulated widely so that it does not remain confined merely to the hospital concerned. Perhaps we should have a national register of mistakes that have been made. It is also important to have a record of good practices, and to see that they are duly disseminated throughout the country, and not limited to the organisation concerned.
	This final point interests me enormously. The Bill is said, rightly, to have been designed not merely to deal with small complaints, but also to change the NHS culture, and to alter profoundly patients' experience of the NHS. Although the Bill makes some progress in that direction, I do not think it goes as far as it could and should. A MORI poll conducted on behalf of the Department of Health revealed statistics that are a great compliment to our country, and to the culture that prevails. Only 11 per cent of complainants were interested in financial compensation. In the case of severe damage, the percentage was no higher than 15 per cent. The figures for the United States are between 75 per cent and 85 per cent. Some 34 per cent of complainants were happy simply with an apology; 23 per cent wanted an inquiry, to avoid a reputation of negligence for themselves or others; and 16 per cent wanted support in coping with the consequences of negligence. That would seem to suggest that nearly 73 per cent of our people have no interest in financial compensation.
	That raises some interesting questions. How do we ensure that that culture is sustained and does not become a culture of complaint or compensation? It is not just a question of identifying pockets of negligence and dealing with them; we need a profound transformation of the way in which the NHS functions. We need more openness. Often, consultants take decisions that are not explained to the patients. Like many Members of your Lordships' House, I could cite cases in which a consultant has diagnosed a patient in a particular way and the patient has screamed, "Look, your diagnosis doesn't make sense. It does not fit in with my history" and still the diagnosis is registered on the patient's file.
	We also need greater humility on the part of doctors. It is important to bear in mind that some cases of negligence can be attributed directly to the medical staff, while others are the complex product of the system in which decisions are taken. It is important, therefore, not merely to think in terms of identifying pockets of negligence among particular members of staff but to consider the system as a whole and ensure that there are clear rules about how medical decisions are taken.
	There have been cases—I could have cited several—in which, for example, surgery was ordered by a junior doctor, even though the patient was not satisfied that the case warranted surgery, the patient has asked to see a senior registrar, and the registrar has reversed the decision of the junior doctor. If the patient had not had the confidence in himself and the courage to ask for a second opinion, he would have been subjected to the surgery and would either have wasted a large number of days suffering the consequences of it or would have made a request for compensation. The example suggests that, often, in some of the hospitals with which I am familiar, the rules on who is entitled to order surgery and whether—especially in the case of patients who are admitted at the end of the day—surgery can be ordered by a junior doctor or must be approved by a senior consultant are not clear.
	For those and other reasons, although I welcome the Bill wholeheartedly, I suggest that there are some loose ends that need to be tightened up. I hope that, in Committee, the Minister will explain why those changes should not be made or will be gracious enough to incorporate them into the Bill.

Baroness Barker: My Lords, I take to heart the comments made by the noble Lord, Lord Colwyn, about points already raised. Eight out of the nine speakers before me have asked similar questions. Perhaps I may add more to the list.
	We learn a lot about a Bill from its advent. The advent of this Bill has been both strange and telling. After First Reading it received a fair amount of sympathetic publicity—and then nothing. There was a deafening silence. Until late last week Members of the House were receiving a flood of detailed briefing, all of which has been supportive of the principle behind the Bill and all containing a range of questions from people with a degree of expertise in this field. That has set the tone of our debate. Our bizarre job over the next few weeks will be to encourage the Minister to demystify an awful lot of what is in the Bill.
	I am reminded of an occasion when, in discussion with one of the Minister's predecessors on one of those annual Bills that takes our NHS system to bits and puts it back together again, I wondered aloud whether the day would come when this House would consider a Bill that stated: "There is the Secretary of State and here is a list of regulatory powers". To my horror, I think that that day has come. I am going to put a lot of questions to the Minister because I think it is right to do so. It will save Members of the House valuable time at later stages.
	Anyone who has tried to make sense of the Bill will have found two documents extremely helpful. The first is Making Amends, in which the Chief Medical Officer sets out the need for a scheme and the key elements necessary to make it effective. To the extent that the Bill before us reflects the recommendations made in Making Amends, it has our support. However, as a number of speakers have already pointed out, key recommendations in Making Amends are not included in this legislation. In our view, the principal omission is the duty of candour on health professionals. That is a deficiency and one that we will seek to address during the passage of a Bill which in principle we very much welcome and support.
	The other helpful document is the Full Regulatory Impact Assessment which sets out in detail the background to and rationale for the Bill, and the need for primary legislation. Two very telling statements are made in the assessment, which point out clearly the need for this legislation and its main failings. The first states:
	"New primary powers will enable the delivery of the reforms listed above, and will enable the Scheme Authority to seek financial contributions from participating local bodies and enable these funds to be used to fund the Redress Scheme. Duties could not be imposed on FTs [foundation trusts] and independent providers other than by primary legislation".
	That is a very revealing statement and, were it not for the need to legislate for the inclusion of foundation trusts, I wonder whether the whole matter would have been dealt with by regulation. However, it is a mark of the deficiency of the legislation before us that even informed commentators have had to ask at every stage whether this Bill does indeed include foundation trusts, because they are not mentioned in Clause 1(2) or (3)
	That statement also goes to an issue which so far no one has mentioned. The NHS Redress Bill is just one of a series of measures such as PALs, ICAS and NHS complaints systems designed to enable people to make complaints against the health service. Each of those elements has an intrinsic value, but together they do not add up to a coherent and consistent means by which citizens can hold the NHS fully to account. Now is not the time to rerun arguments about the abolition of the CHCs, but it is fair to say that the range of measures which the Government have put in their place does not offer an effective and efficient system of representation for individuals, nor do we have a robust system of monitoring and addressing failures of healthcare across geographical locations or in respect of distinct patient populations. The noble Baroness, Lady Morgan of Drefelin, said that the measures were "convoluted" and I am concerned that this may be just one more convolution. Moreover, many noble Lords have mentioned one glaring omission; that is, any provision in the Bill for the dissemination of information. Without that it is difficult to see how learning across the NHS can be enhanced.
	The opening statement of the Full Regulatory Impact Assessment talks of primary legislation in the following terms,
	"new coherent powers to enable the scheme to be set out within a single framework of regulations as a real alternative to legislation, and one that will be more readily understood by patients and NHS staff alike".
	That is not what we have at the moment. Specialists in the field do not understand it, so I do not see how lay people can. Yet the statement gives your Lordships a good target at which to aim.
	We have a number of reservations. Some have already been mentioned. The lack of independence of the scheme is a key one, which many of your Lordships have mentioned. The lack of specialist medico-legal advice during the course of an investigation was raised most eloquently by the noble Baroness, Lady Morgan of Drefelin, and by the noble Baroness, Lady Tonge. On these Benches we are concerned not only that patients should be fully enabled to understand the process that they are being taken through, but also that NHS staff can have faith in a system which will explain to people—in much better terms than any existing complaints system—what is happening. The current system has been described by the BMA as harmful, unpredictable and unjust. So it is; but we believe that the Bill, were it to be properly framed, could rectify that.
	One other recommendation by the Chief Medical Officer in Making Amends was that an avoidability test would be preferable. On these Benches, we would like to see that approach probed—not least because it would shift the blame away from individual practitioners and focus, perhaps, more on systemic failures. I listened with great care to the noble Baroness, Lady Finlay of Llandaff, as she made her defence of the Bolam test. Having listened to her, it seemed that there was nothing in what she said that could not have been understood by a patient. It was the sort of full explanation that patients often look for but frequently do not get. If they were getting that quality of information, then a great many cases would not come forward in the first place. An avoidability test, running alongside initiatives such as the National Patient Safety Agency in its Being open programme, would change practice in ways that would be preferable. We should spend time in Committee looking at that.
	Another reason for drawing attention to the avoidability approach is that the Bill, as it stands, appears to refer only to clinical or medical errors. What is not clear is whether the scheme would include cases in which a wrong diagnosis was made, or a wrong course of treatment pursued for another reason—for example, administrative failure. Clause 1 lists the healthcare staff whose actions are included in the scheme, However, it is not possible to tell, for example, if a lab technician makes a technical mistake or uses equipment which renders a treatment faulty—and that, in turn, causes wrong treatment down the line—whether that will be covered by the scheme. The noble Baroness, Lady Tonge, made that point well.
	There are a number of detailed questions I wish to put to the Minister at this stage. I believe doing so will improve the quality of debate at subsequent stages of the Bill. Clause 1 refers to diagnosis of illness. It does not state that the scheme includes advice given to a patient. Why? Clause 8 concerns the provision of legal advice. What research has been done to ascertain the effect on the Legal Aid Fund? In Clause 8(2) there is reference to a "specified person" who will prepare a list of providers of legal advice. Who will that specified person be?
	Clause 9 deals with assistance for individuals seeking redress under the scheme. It is not clear who should provide the advice, or how they will be paid. Noble Lords will require clarification of that. Clause 9(1) appears to be a provision for the Secretary of State to be given the power to appoint a representative to assist an applicant:
	"by way of representation or otherwise".
	What does that mean?
	Clause 10 refers to the requirement on members of the scheme to make payments. On what basis will contributions be made? Will there be a per capita basis for members of the scheme? Will the fees be risk-related? Will members of the scheme who carry out more complex procedures have to pay weighted contributions? Or will members who have a comparatively poor track record have to pay higher levels of contributions?
	Clause 10 also requires a scheme member to charge a specified person with responsibility for overseeing the scheme. How will that requirement relate to clinical governance and existing complaint arrangements?
	Clause 12 deals with the extremely important matter of disclosure but its drafting is extremely confusing. Does the clause apply to applicants, to scheme members or to both? Access to information is at the heart of any process of investigation or redress and it would be in the best interests of the debate if the Minister could answer this question at an early stage.
	I have one final set of questions for the Minister. How will the scheme be monitored, reviewed and evaluated? How will learning from individual cases be made known and acted upon throughout the NHS? That will be the true test of whether or not the proposals work. It could turn a cost-avoidance measure into a real driver for change and improvement.
	The Minister will be well aware from today's debate that there is good will towards the Bill. This reflects the good will of the population towards the NHS and, as the noble Lord, Lord Parekh, has told us, the desire among people in Britain to remain supportive of our National Health Service and to prevent an American-style litigation culture entering our healthcare system. This kind of legislation involving technical matters comes up once in a very long while, but it provides an important opportunity for the House and Parliament to be at one with the British people in saving our NHS from unnecessary and undue interference from litigation. For all those reasons, I hope the Minister will be expansive in his answers and enable us to speed the passage of the Bill, in an improved form, through the House.

Baroness Morris of Bolton: My Lords, I, too, thank the Minister for his clear explanation of the Bill and I pay tribute to the vast expertise and knowledge that has been shared today in your Lordships' House.
	It may be a small Bill, but it has stirred much interest. My own interest stems from when I was a board member and deputy complaints convener of the Salford Royal Hospitals NHS Trust. I say to the noble Baronesses, Lady Murphy and Lady Tonge, that the drafting of letters and getting the tone right is not easy. After one investigation I wrote a letter which was open, warm and understanding—and was immediately reported to the ombudsman because it was not legalistic. I say to the noble Lord, Lord Turnberg, whom I first met at Hope Hospital, that his voice sounds lovely and that it did not affect his customary good common sense in any way whatever.
	As my noble friend Lord Howe said in his opening speech, the need to reform the system is plain. We are glad that legislative time has been found to consider this issue, albeit two years after the Chief Medical Officer's excellent second report, Making Amends. As my noble friend Lord Colwyn said, we support the idea of greater openness between patients and the medical establishment when things go wrong, but share the concerns so eloquently expressed by the noble Baroness, Lady Neuberger, about how effective that will be.
	We would have liked to have seen greater encouragement of mediation to resolve disputes. The use of mediation has received wide support from a number of bodies, including the NHS Confederation and doctors' groups, and the NHS Litigation Authority has itself adopted a positive policy of encouraging the use of mediation.
	Dr Stephanie Brown of the Medical Protection Society said:
	"The move away from purely financial compensation towards a more comprehensive package of redress for patients including an apology [and] explanation . . . is positive".
	And yet, by focusing, as this Bill does, on monetary compensation, the importance of factual investigation and the knowledge gained from lessons learnt are relegated.
	As many noble Lords have mentioned, and as my own experience has taught me, the majority of people who seek redress from the NHS simply want an answer to the many questions they ask themselves. They want the opportunity to meet the clinicians face to face. In some cases that will be an important part of the grief process, a necessary component if families and individuals are to move on with their lives. Some just want someone to say that they are sorry. There is also a strong sense of the greater good, a need to know that things will change and that wherever possible the same thing will not happen to another person.
	An important litmus test of any scheme that seeks to rectify a wrong is public confidence in that scheme. The Bill will not increase public confidence in the NHS redress system if it enables the NHS to be judge and jury. If the NHS investigates the fault and then awards compensation against itself there is a clear conflict. We on these Benches agree with the noble Baroness, Lady Finlay of Llandaff, that the redress scheme should be robust and limited to an independent fact-finding investigation with the power to make recommendations to avoid the recurrence of similar events. It should not extend to finding blame or paying compensation. The factual explanation received can be used as the basis of a compensation claim which may have a better and fairer outcome for the patient outside the redress scheme. Our proposals reflect patient expectations and priorities.
	We support steps to encourage and support those with a real claim but seek to prevent those looking to attack the NHS unreasonably. As the Medical Protection Society has said,
	"a fair balance needs to be achieved between the rights of patients to receive compensation and the rights of healthcare workers not to be criticised unfairly".
	The Bill takes no measures to protect the NHS against spurious claims and also may encourage patients to settle for £20,000 or less when they should receive more. The Department of Health already acknowledges that that may lead to an increase in costs. Indeed, as the Bill provides for free independent legal advice, how does the Minister know that the cost of legal aid will be reduced? There seems little point in replicating structures and bureaucracies within the NHS when they already exist outside, so the Bill must not replicate the work of the courts; particularly when the Government claim that they are trying to cut down on red tape and improve the effectiveness of public services. Nor must it be allowed to become a free lunch ticket for ambulance chasers.
	The Bill gives the Secretary of State the power to establish, by regulation, a scheme for the victims of medical accidents to obtain redress without recourse to legal proceedings. There have been major concerns that it is a little light on detail. To pick up on an important point made by the noble Baroness, Lady Morgan of Drefelin, if patient X turns down an offer of compensation under the scheme having received free legal advice, will he be denied access to legal aid?
	As my noble friend Lord Howe highlighted, we will be looking during the course of the Bill to flush out more detail on how the scheme will operate, who will be making particular decisions, the eligibility criteria and awards available. As the noble Baroness, Lady Barker, said, the Bill raises many questions. We will be taking a close look at Clause 11 and like the noble Lord, Lord Parekh, we will want to question the composition of the body that will run the scheme and the nature of any tribunal that will determine liability.
	There appears to be a provision in Clause 9(1) for the Secretary of State to be given the power to appoint a representative to assist an applicant,
	"by way of representation or otherwise".
	We would like to probe the intention of this clause. Any applicant under the scheme, if he or she so wishes, must have the freedom to make their own choice of a person or organisation to assist with any claim. In the absence of freedom of choice, doubts are bound to arise about the impartiality of the adviser.
	The Health Minister, Jane Kennedy, said that her priority is,
	"to encourage openness and a culture that is willing to acknowledge when things have gone wrong".
	The Bill presented the Government with the opportunity to do just that. Yet I share the concerns of my noble friend Lord Howe and others that this opportunity was wasted.
	The British people are not revengeful. Nor do I believe that we yet have a compensation culture. Research shows that following a clinical event that goes wrong, most patients are not after money; as the noble Baroness, Lady Morgan, said, they just want an explanation and, where appropriate, an apology. By concentrating as it does on compensation, our greatest concern is that through the Bill, we may end up with the one thing that we are trying to avoid.

Lord Warner: My Lords, this has been an interesting debate on an important Bill but, I have to acknowledge, there have been varying degrees of enthusiasm for the Government's approach. However, I take some comfort from the level of support for the Bill's underlying principle that those who are damaged by their healthcare deserve a better response than the one they currently receive.
	I was a bit disappointed by the approach of the two Opposition Front Benches; we will no doubt come back to their concerns in Committee. I gently say to the noble Earl, Lord Howe, that I was a bit surprised to hear, by his own acknowledgment, that the Conservative Front Bench wanted to create a lengthier, more bureaucratic scheme involving a second body—the Healthcare Commission, possibly—which already has onerous duties. I was particularly surprised, given the noises that have come from the Conservative Front Bench in the other place about excessive bureaucracy and the need to cut red tape. I ask the noble Earl to reflect on the fact that when we get to Committee, we shall look very carefully at whether proposals from Opposition parties would make the scheme lengthier, more bureaucratic, less easy to work and would create a more complicated set of arrangements for patients to work their way through. I hope that we will be able to keep those considerations in our mind as we discuss the details of the scheme in Committee.
	A number of noble Lords referred to the report Making Amends and have implied that we have cavalierly dropped most of the Chief Medical Officer's recommendations. The NHS redress scheme is designed to take forward one recommendation, but we are working with other government departments to take forward other reforms proposed in Making Amends. For example, we are taking forward recommendations 6 and 8 on reforms to the NHS complaints procedure and we are considering taking forward recommendation 17, which will prevent court awards reflecting the cost of private treatment as part of wider reform to Section 2(4) of the Law Reform (Personal Injuries) Act 1948 in conjunction with the Department for Constitutional Affairs. I am very happy to write to noble Lords before Committee to set out how some of the proposals are being taken forward in a different way outside the Bill, so that there is no misunderstanding when the Bill reaches Committee.
	A number of noble Lords have referred to why the scheme for severely neurologically impaired babies is not in the Bill. Since Making Amends was published, the National Service Framework for Children, Young People and Maternity Services has been published. This is a 10-year plan and includes a developmental national standard to address the requirements of all young people who are disabled. On 12 October 2005, we published a statement of intent which sets out action planned and already under way to meet the complex needs of this group of children.
	I remind noble Lords that, because of the high value of financial redress attached to such cases, severely neurologically impaired babies are likely to be outside the scope of the NHS redress scheme. However, I can give further and better particulars on this issue to noble Lords in writing before Committee.
	Several noble Lords asked why the scheme does not currently cover primary care settings. Most incidents of clinical negligence in primary care settings would result in very small-value claims the handling of which would incur high administrative costs. GPs and other primary care practitioner organisations have private indemnity arrangements with the Medical Defence Union and the Medical Protection Society. As the noble Lord, Lord Turnberg, said, these are private organisations which collect insurance-type premiums from their members. Further discussions need to be held with the stakeholders to establish how funding flows would work if the NHS Litigation Authority as the scheme authority were to take over a significant proportion of their low-value claims via the NHS redress scheme. Inevitably, that would need amendments to legislation, but it is a complicated issue.
	The issue of rights of appeal was raised by a number of noble Lords. At present, the Bill does not propose the right of appeal, but if a patient is dissatisfied with an offer made under the scheme, the patient may reject the offer and seek redress through the courts. Patients will get access to the independent legal advice on the offer that is made to them without charge.
	I was asked whether there would be an independent element. The aim of the NHS redress scheme is to support local resolution. However, where patients are unhappy, a complaints procedure will be in place.
	Several noble Lords asked about time limits. The detail of the scheme will be set out in secondary legislation. I assure noble Lords that it is intended that full consultation will take place to ensure that the fine detail of the scheme—such as the exact time limits that will be set at each stage—is worked out in a way that enables the scheme to operate effectively in practice.
	I could not resist smiling—the noble Baroness, Lady Tonge, caught me—when she was delighting the House with stories of exhausted health professionals bowed down by government targets. I remind her gently that those targets arose because patients actually made the not unreasonable request that we improved access to GPs, improved accident and emergency services and had shorter waiting lists. I am sorry if she and her colleagues are bowed down, but I read recently in the media that our GPs were actually paid rather well compared with the rest of Europe so there seems to be some compensation for the onerous responsibilities that they discharge. As I remember, GPs were relieved of their obligations on out-of-hours services under the changes that we introduced as a result of discussion with them. I thought that we should put the record straight in that particular area.
	Noble Lords raised the important issue of whether we could be heading towards a US-style litigation culture. The noble Baroness, Lady Murphy, touched on that. In terms of clinical negligence claims specifically, claims against the NHS actually continue to fall. An average of 439 claims per month were made under the clinical negligence scheme for trusts in 2004–05 compared with 481 in 2003–04. That is still more than we would like, but the trend is not going upwards: it is going in the opposite direction.
	Several noble Lords, and the noble Baroness, Lady Finlay, in particular, raised the issue of the Bolam test. Any offer of redress will be made only on the basis of a liability in tort arising under the law of England and Wales. The same test for negligence as applied in civil proceedings will be applied to cases under the redress scheme. Those tests are currently the Bolam and Bolitho tests. The Bolam test provides that a professional is not negligent if their practice was in accordance with that accepted as proper at the time of treatment by a responsible body of medical opinion, even though other doctors adopt a different practice. I will not go into the detail of that, but I am trying to reassure her that we are not changing the test in any way under this legislation.
	The noble Lord raised the issue of the NHS Litigation Authority having a conflict of interest. I am anxious not to end up with such a complicated set of arrangements that they are off-putting to patients. It is intended that any patient who is offered a settlement under the scheme will be given the opportunity to have the offer assessed by independent legal advice, which will be provided without charge. It is not just the NHS Litigation Authority calling all the shots, although it has considerable expertise. We can go into the detail of determining liability at the appropriate level in Committee. The measure has a lot to offer, and I hope, in Committee, to convince your Lordships of that.
	Noble Lords have rightly chided us and asked when they will know the detail of the scheme. Regulations will not be published until after Royal Assent, but there will be full consultation on draft regulations before the scheme starts, which we envisage to be April 2007. The issue of whether it will take the NHS in the wrong direction regarding how it deals with patients' concerns has been raised. We know, and I shall give further and better particulars in Committee, that many of the best trusts are already looking at how best to respond to patients when things go wrong. We want to support all NHS organisations to reach that standard, and we think that the Bill will help to do that.
	The issue of whether the NHS redress scheme will cover MRSA was raised. The scheme will cover claims arising out of hospital services provided to patients as part of the National Health Service in England. It may cover cases involving MRSA if there is liability in tort and the case falls below the financial threshold. I like dealing with health Bills in this House as we invariably get on to the issue of cross-border flows between England and Wales. No doubt we shall discuss that subject in Committee when I shall no doubt receive support from the noble Baroness, Lady Royall. I can tell the noble Baroness, Lady Finlay, that the Department of Health and the Assembly have been working together on the proposals. Wales has broad regulation-making powers that do not commit it to establishing a scheme. However, clear guidance will be developed for all cross-border services, and commissioning responsibilities will be agreed at the outset. There will be no uncertainty for patients or providers.
	I was asked whether doctors would be blamed, but the scheme is intended to resolve claims outside the adversarial process. We do not think it is likely that the scheme will increase the possibility of doctors being blamed. Claims under £20,000 currently cover about 75 per cent of settled claims. My noble friend Lord Parekh asked about the number of claims involved in the past few years. The average number of settled claims under £20,000 in financial years 2001–02 to 2003–04 was around 4,000 a year. That represents approximately 75 per cent of settled claims. I was asked whether the cost limit included remedial treatment costs. It does not. Remedial care based on clinical need will be provided under the NHS as a matter of course in particular cases.
	The noble Baroness, Lady Barker, asked who would hold the list of solicitors. It is intended that the list will be made available by the Legal Services Commission. She also asked whether misdiagnosis would be covered. Any case when there is a liability in tort, based on the current legal test, will be eligible, provided that liability arises out of services provided in hospital and in consequence of the act or omission of a healthcare professional. That would be the test applied if there were concerns about misdiagnosis.
	I was asked how the scheme would be funded. We expect it to be funded along the same lines as the clinical negligence scheme for trusts. The detail of the funding mechanisms will be set out in secondary legislation and the contribution paid by each scheme member will be advised by the NHS Litigation Authority. Contributions may be adjusted in the light of the relevant risk rating of each individual scheme member.
	I have tried to cover as best as I can some of the issues raised. I assure noble Lords that I shall study Hansard carefully and will reply to all the questions to which I have not given full and frank answers in this debate. As it is in my best interests, I shall endeavour that the letters get to noble Lords before Committee, so I can guarantee to write to noble Lords on those particular issues.
	On Question, Bill read a second time, and committed to a Grand Committee.

Lord Bowness: rose to move, That this House takes note of the report of the European Union Committee on the European Union's Role at the millennium review summit.

Lord Bowness: My Lords, this relatively short report was produced during the summer in anticipation of the millennium review summit, which was held in September. Before turning to the substance of the report itself, I record my thanks to the members of Sub-Committee C of the European Union Committee for their work in the preparation of the report; to Benita Ferrero Waldner, the Commissioner for External Affairs; to Mr Daws, the Executive Director of the United Nations Association in the United Kingdom; to Sir Jeremy Greenstock, the former representative of the United Kingdom to the United Nations; and to Mr Douglas Alexander, the Minister for Europe, for giving evidence to the committee. I also record our particular thanks to the noble Lord, Lord Hannay of Chiswick, who, before joining the sub-committee as a member and assisting us with his knowledge and expertise of the subject also, as long ago as May 2004, gave evidence to the committee on the work of the Secretary General's high-level panel of which he was a distinguished member.
	There was pressure to produce the report by the summer, and I am grateful to Emily Baldock, the committee clerk, and Pamela Strigo, the committee specialist, in the drafting of the report and enabling us to meet our self-imposed deadline.
	The report has inevitably been overtaken by the events to which it looked forward, and I know that the noble Lord, Lord Hannay, will deal with the outcome of the millennium review summit, so I do not propose to dwell too long on that myself. But it is worth looking at the report and the Government's response. In September 2005, the heads of the United Nations member states met in New York to mark the United Nations 60th anniversary. They were there to review the progress of the millennium development goals on the basis of the report commissioned from the Secretary General, entitled In Larger Freedom, but that report went much further. It was divided into four sections, which our report tends to follow. A much larger point was, as our report states, the question of the United Nations' role in the post-Cold War world.
	We, as a sub-committee of the European Union Committee, were anxious to see what the European Union's role would be in that. The Secretary-General's report, In Larger Freedom, consisted of four main themes: Freedom from Want—the Development Agenda; Freedom from Fear—the Security Agenda; Freedom to Live in Dignity—Human Rights and Democracy; and Strengthening the United Nations—Reform of the Institutions. The sub-committee recognised at the start that the United Nations is an organisation of sovereign states. The European Union has only observer status, but we also observed, and witnesses confirmed, that among the many groups there, the European Union stands out as the most cohesive and the one that is most likely to assist in collective action. One of our recommendations, which one might have thought was a statement of the obvious, was that to ensure and endeavour to achieve a successful outcome at the summit, the European Union must advocate the case for reform, use its particular relationship with the United States and have a dialogue with countries in the other continents.
	The Secretary-General, in the "Freedom from Want" section of his report, urged all the UN member states to implement the global partnership between rich and poor countries. It is worth noting that the committee commended the European Union for its pre-stated commitment to increased aid. The EU is still the largest contributor to overseas development aid.
	We also commended the Government for having made a brave and principled decision to pick climate change as one of their key priorities for the United Kingdom's European Union and G8 presidencies. We urged the Government to seek agreement at the conference to begin in November and proposed that a specific date for the post-2012 discussions be included in the millennium review summit draft outcome document. We would like to hear from the Government whether those discussions commenced on time.
	Regarding "Freedom from Fear—the Security Agenda", we urged the European Union to,
	"press for new principles on the application of force",
	and we endorsed the concept of the responsibility to protect. We are pleased that that was recognised. We also suggested that the Government should press for as much detail as possible in the conclusions regarding the setting up of a peacebuilding commission. Although the Government agreed with that in their response, one of the key issues as we see it is that it is not clear how that will relate to and work with the Security Council. It would be extremely helpful if the Minister could respond to that. We were also concerned that a definition of terrorism should be achieved at the summit. That has not happened and, with great respect to the Government, their response is set out in rather complacent terms, bearing in mind that that was a particularly important issue.
	Regarding the section, "Freedom to Live in Dignity", the sub-committee supported the proposal for a new human rights council which we hoped would be more effective than the existing institution. We hoped that the Government and the European Union would support the measures proposed at the summit that would strengthen the UN's human rights machinery. As we understand it, that new institution was established but, again, can the Minister give us more detail and information on the progress that has been achieved?
	On the reform agenda, strengthening the United Nations institutions, we always knew that reform of the Security Council was not a matter on which the member states of the European Union would be able to agree. Indeed, that proved to be the case. We also called for the Government to indicate how they believed the United Nations General Assembly could, in the words of the report, be revitalised and work towards the Secretary-General's reforms. The government response indicates that a working group was set up, but it does not indicate what proposals and measures the Government would advocate and be pressing in conjunction with our partners in Europe.
	Lastly, I draw noble Lords' attention to the fact that, while the outcome of the summit achieved only partial success, the European Union itself was successful in producing a co-ordinated position at the summit. As I have already said, with the exception of the Security Council, that co-ordinated position seems to have been maintained throughout the process. By focusing on the areas of agreement, the European Union was able to contribute positively to the positive elements of the outcome of the summit—a lesson which we should perhaps consider when we sometimes discuss the desirability, or not, of having a common foreign and security policy. Failure to be able to agree on absolutely everything is no reason not to try to achieve agreement on as much as possible. The result of the summit in that regard at least suggests that those efforts were not only for Europe's collective benefit but also for the benefit of the United Nations. I beg to move.
	Moved, That this House takes note of the report of the European Union Committee on the European Union's Role at the millennium review summit.—(Lord Bowness.)

Lord Truscott: My Lords, I begin by commending the noble Lord, Lord Bowness, for the excellent way in which he guided the EU Sub-Committee C through all the various stages of the report. As the noble Lord mentioned, we also benefited from the expertise and special knowledge of the noble Lord, Lord Hannay, who appeared as both a witness and a committee member and greatly assisted in the drafting of the subsequent report. I look forward to hearing his speech later in the debate.
	The importance of the EU/UN relationship is self-apparent. EU member states are the largest financial contributors to the UN system, as the noble Lord, Lord Bowness, mentioned. The EU pays 38 per cent of the UN's regular budget, more than two-fifths of the UN peacekeeping operations and around half of the UN member states' contributions to UN funds and programmes. Thus, in my view, the committee's report is both timely and an important contribution to the debate about the role and influence of the EU within the structures of the United Nations.
	Overall, as the Minister, my noble friend Lord Triesman, told your Lordships' House on 10 October, the resulting millennium review summit,
	"delivered a worthwhile package of reforms and commitments".—[Official Report, 10/10/05; col. WS 10.]
	My own feeling is that, although there were disappointments at the September UN world summit, there were also significant advances. The noble Lord, Lord Bowness, mentioned that one of those advances was the way in which the EU member states themselves maintained a co-ordinated approach to the negotiations at the summit. I would argue that the outcome was not as disappointing as some commentators would have your Lordships believe, and I hope that the Minister, in responding to the debate, will concur.
	There was a strong and unambiguous commitment by all governments, of donor and developing nations alike, to achieve the millennium development goals by 2015. An additional $50 billion a year would be found by 2010 to fight poverty. There was agreement to provide immediate support for quick impact initiatives to support anti-malaria efforts, education and healthcare.
	For the first time, the UN agreed a clear and unqualified condemnation of terrorism by all governments,
	"in all its forms and manifestations, committed by whomever, wherever and for whatever purposes".
	There was a strong push for a comprehensive convention against terrorism within a year and support for early entry into force of the nuclear terrorism convention. The Government managed to secure the adoption of the Security Council resolution calling on all countries to ban the incitement of terrorist acts, despite the failure to agree on a definition of terrorism, as the noble Lord, Lord Bowness, mentioned.
	UN members could not agree on a definition of terrorism that treated attacks targeting civilians and non-combatants by non-state agents as terrorist acts. The logic is that similar acts by governments are already proscribed as war crimes. Some countries insisted that the definition of terrorism should exclude "legitimate" struggles for liberation and self-determination.
	Although it is often said that one person's terrorist is another person's freedom fighter, it is disingenuous to suggest that blowing innocent children, women—and men, for that matter—to pieces in any political cause is other than terrorism. Was the killing of more than 150 children in Beslan in North Ossetia in September 2004 not terrorism because some of the terrorists felt that they were fighting for self-determination? I think not. Of course the world must avoid double standards, but, on the other hand, the civilised international community is entitled to say that there are lines that rational human beings should not cross, whatever the cause, whatever the war.
	The UN world summit also agreed to build a peacebuilding commission backed by a support office and a standing fund. There will also be a standing police capacity for UN peacekeeping operations. Human rights machinery is to be strengthened; a human rights council established within a year; the Convention against Corruption came into force; and a new ethics office, badly needed following the Volcker reports, will help strengthen internal oversight. There was recognition of the serious challenge posed by climate change and a commitment better to tackle HIV/AIDS, TB and malaria. An improved Central Emergency Revolving Fund would ensure that relief arrived more swiftly and reliably when disasters happened. The signatories reconfirmed the Monterry consensus, in which they pledged to,
	"make concrete efforts towards the target of 0.7 per cent of GDP in official development assistance".
	Of course, the key is to turn those fine words into action. That process should be helped by a little-noted clause, paragraph 22a, in the outcome document, in which all UN members agree to,
	"adopt, by 2006, and implement comprehensive national development strategies to achieve the internationally agreed development goals and objectives, including the Millennium Development Goals".
	From now on, development strategies prepared by bodies such as the International Monetary Fund and the World Bank should be comprehensive and designed to achieve the development goals. That is a new concept which, it is hoped, will force a change in the behaviour of institutions and governments around the globe.
	Another major breakthrough was the clear and unambiguous acceptance by all governments of the collective international responsibility to protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity. When peaceful action proves inadequate and national governments refuse to act, the Security Council will have the responsibility to protect the innocent. The responsibility to protect, which was initially resisted by Egypt, Algeria, Pakistan, India, Russia, Cuba, Iran and Syria, was finally pushed through in New York. The UN world summit is to be congratulated for overcoming resistance among some of its participants to the principle that people sometimes need to be protected from their own governments.
	Of course, the world summit was not a resounding success in all areas, as I mentioned in the case of the definition of terrorism. Secretary-General Kofi Annan rightly said that it was a "disgrace" that no progress had been made on disarmament at the summit. The committee's report before your Lordships' House stated that the earlier NPT Review Conference was a "disastrous failure" and that non-proliferation should have been one of the Government's priorities in New York. The Government's response to the committee's report acknowledges disappointment in that area and promises to,
	"find pragmatic solutions to overcome that setback and enhance the non-proliferation regime".
	In the dangerous world in which we now live, solutions cannot come soon enough. I hope that the Minister will reflect on the response required by the Government in this area.
	Post-2012 climate change commitments will be discussed at the December 2005 climate change conference, but the UN review summit itself took no decision on further international action. On both the peacebuilding commission and the human rights council, issues still remain outstanding. Progress on the issue of Security Council reform, on which the noble Lord, Lord Hannay of Chiswick, expended so much effort as a member of the High Level Panel, was non-existent.
	The only positive thing which could be said about Security Council reform was that the subject did not derail to whole millennium review summit, as some feared it might. Reform of the General Assembly also seems some way off. Consensus among a body with 191 member states is understandably sometimes beyond the reach of even the best diplomats.
	The UN millennium review summit achieved a lot but, as someone once said, there still remains a lot to be done.

Baroness Falkner of Margravine: My Lords, before I commence, I should declare an interest in the context of this report for those Members who have not seen the report itself, in saying that the House may wish to know that my sister is UN Deputy High Commissioner for Human Rights. Having said that, I have not consulted her at all in forming my opinions on the report.
	I came to the committee in the final stages of its deliberations on the report. The analysis within it is extremely pertinent to the many issues that the UK will have to grapple with in the remaining time of its presidency of the EU. In those late hours as the report was being finalised, I should extend my thanks to our chairman, the noble Lord, Lord Bowness, whose wise guidance on what we should really focus on was invaluable to a new member like myself.
	UN summits are not always as relevant as they might be. However, given contemporary geopolitics and the state of multilateralism, both in the wider framework and within the EU itself, this summit was always going to be a testing one. In aspiring to do as much as it sought, the UN was perhaps being over-ambitious. Perhaps it should have concentrated on the critical areas of how we might actually achieve the millennium development goals—no small matter when it comes to halving extreme poverty, providing an education for all the world's children or combating the reduction of infectious diseases—rather than attempting to embrace the broader, but also deeply important, agenda of UN reform.
	In the committee, we too had a wide-ranging agenda in reviewing EU relations with the UN. I will confine my remarks to three areas only: the convention on terrorism, the Human Rights Council and the reform of the UN organisational structure. In doing so, I wish I was speaking after the noble Lord, Lord Hannay of Chiswick, as his knowledge of matters relating to both the UN and the EU is far superior to almost anyone else in this House and therefore much of what I say may well be made redundant when he speaks.
	In representing the EU at the UN, and bearing in mind how much more important the EU is to the UN now, given that we contribute, as many noble Lords have said, almost 40 per cent of the regular budget, the UK Government had particular leverage at this summit. That it was able to achieve as much as it did in the context of the MDGs, and particularly in achieving agreement on responsibility to protect, is to be congratulated. However, given that the EU went into this summit in a more united position than the recent past—one only has to think back to 2002 and 2003, when EU divisions would have been rather more evident—it is to be regretted that more could not be achieved.
	A significant failure was the inability of the UN to arrive at a successful outcome on the convention on terrorism. Had that been achieved, it would have been of more than symbolic importance, as it would have resulted in genuine commitment on the parts of other states to meet their responsibilities in this regard. The reason we were unable to get agreement was that the Organisation of the Islamic Council, which represents 57 Muslim countries, was reluctant to agree terms whereby legitimate struggle for autonomy and/or self-determination could be made unlawful. As many of those struggles relate to Muslim populations—not least those in Palestine and Kashmir, not forgetting the plight of Chinese Muslims or those in Russia—it was not entirely surprising that we could not succeed. So we will probably not gain agreement on this most contentious issue of our time, and that is to be regretted.
	We should note in the context of terrorism that the UN Security Council did indeed agree Resolution 1624, which is wide-ranging. I mention it because the Government have invested so much political capital in this resolution, recalling time and again that it is now under obligation to abide by that resolution in the context of the Terrorism Bill which is currently being debated in the other place. But there is a warning here: we must be very careful not to adopt a pick-and-choose approach to international law or we will bring it into disrepute. So while our Government remind noble Lords on the opposition Benches of their commitments to multilateralism, they might pause to reflect on their own standards of adherence to measures for international peace and security in contemporary times. They should also note those sections of the resolution that call on states to take measures as may be "necessary and appropriate". The resolution also stresses that states must ensure that measures comply with international human rights law. I could go into detail about why I think that Resolution 1624 does not comprehensively support the Government's case, but this is not the debate for that.
	A further disappointment was the lack of progress on agreement for a human rights council. That was all the more disappointing as, I believe, the concern of certain developing countries that the new council would sideline them and work only to the Western agenda was predictable—and what is predictable is, to some extent, resolvable. The failure to move forward in that regard can be explained partly by the lack of dialogue between those who could see themselves losing voice through the reforms and those who would gain. With greater forward planning we might have had progress.
	The debate will now centre on how wide the membership of the council should be. I have some experience in that regard: in addition to the interest that I have already declared, I worked for the Commonwealth secretariat for several years and was responsible for the ministerial committee for human rights and democracy. On the whole, the Commonwealth committee—the Commonwealth Ministerial Action Group—has been quite successful. In response to violations of fundamental principles in relation to Zimbabwe and Pakistan, it was able to bring some sanctions to bear. If the human rights council is to have any influence in advancing human rights, the one lesson that we should draw from the Commonwealth is to keep the council a reasonable size to achieve coherence for oversight. Current thinking is that the council may have as many as 47 to 50 members. That should be avoided. Creating a body with a quarter of the membership of the UN will not be the recipe for achieving either consensus or common positions. An effective council must have a manageable membership, and the EU should bear that in mind, even if it has to compromise its own interests in terms of membership and numbers. In doing so it will advance the cause of human rights overall, and that must be a good thing.
	Finally, I come to the overhaul of the UN system itself. The UN Secretary-General commented two years ago that the UN was at a fork in the road: on one side lay reform and renewal and on the other lay growing irrelevance. Those sentiments expressed a growing sense of frustration among capitals that the UN could no longer just muddle along; however, that seems to be where we find ourselves and where the EU, as a significant contributor across the board, has much leverage. That it failed to achieve the required reforms will have direct implications for the UN's present accountability and future mandates. At present, the mismanagement of the oil for food programme is a case in point. As the Volker report made clear, the split responsibilities between the secretariat, the Security Council and the General Assembly render the lines of accountability much more diffuse. An overhaul of the UN staffing regime is also needed, if only to clear out dead wood with a move to greater flexibility to achieve staff turnover, which would greatly benefit efficiency. A streamlined secretariat, with clearly defined and greater powers for the Secretary-General, is needed.
	Overall, the summit was a missed opportunity for both the UN and the EU. That we failed to achieve the radical but necessary reforms means that we will have to muddle through a bit longer. However, a debate is now under way, and we must be determined to continue pushing the reform agenda even as we hand over the EU presidency. Our responsibility as a permanent member has historically been discharged with great commitment. We look forward to renewal of that commitment towards both the UN and the EU.

Lord Watson of Richmond: My Lords, I add my congratulations to the noble Lord, Lord Bowness, and his committee for a report which is timely, lucid and highly relevant. The report is precisely titled but, as the debate has already demonstrated, it raises wider questions than the European Union's role at the millennium review summit. Indeed, as the introduction states, it:
	"looks at the EU's role in the UN".
	It does that, to an extent, in the round.
	One key question with wide implications arises within the first section of Chapter 3 of the report, "The EU's importance to the UN". Several references have been made to quite startling data, but if I may mention them again; member states of the EU contribute 38 per cent of the United Nations' regular budget, which compares with 22 per cent contributed by the United States. More than 40 per cent of the UN's peace-keeping role costs are met by EU member states. This question, then, seems to arise logically in my mind: is the EU's role in the United Nations, and through it, commensurate with its budgetary contribution?
	Judging by the way the media see this issue, the answer is, "Certainly not".
	When the UN's future is discussed in terms of crisis, it is often because of US scepticism about the UN and, indeed, the desultory nature of the financial contributions of the United States. By contrast, the European Union's contribution, if it is discussed at all, is taken for granted. I suspect that its extent and dimension is little known, and the committee has made an important contribution to the debate by drawing attention to these figures.
	It is unsurprising, in a way, that the European Union's contribution to the UN is somewhat taken for granted because the European Union is based on multilateralism, as indeed is the UN. To an extent, they are birds of a feather. There are, of course, signs now—and many in the House will be pleased about these signs—that the United States Administration is taking the United Nations more seriously than it did at its outset. It nevertheless remains true that, both in its rhetoric and, indeed, in quite large slices of its thinking, the United States Administration is, by instinct and emotion, seriously unilateralist.
	In giving evidence to the committee, Sir Jeremy Greenstock expressed this most tactfully. He said that United States Governments have failed to resolve the dichotomy of wanting, on the one hand,
	"the United Nations to do things to make the world better which the United States does not want to do",
	but opposing the evolution of a global body in the UN,
	"that can take decisions properly the business of the United States"
	That is a very diplomatic expression of the dichotomy, which is clear. It goes to the heart of the difference between the EU and the United Nations, and, indeed, between the EU and the United States, in their approach to these issues. The European Union is not only committed to multilateralism but also, historically and in its whole dynamic, to pooling sovereignty where this enables us to do together what we cannot do separately. In theory, this is what the Security Council is meant to be able to achieve, and historically it occasionally has.
	But it is famously what it was not able to do over Iraq. Again, Sir Jeremy Greenstock, explained why. The European Union, like the United Nations,
	"very considerably is governed in its business by decisions of political leaders in their national context".
	States have to agree, on each issue,
	"whether they will be collective rather than national".
	The report concludes that,
	"This was demonstrated by the divisions over the war in Iraq".
	The question for the European Union, however, given the scale of its contribution, is whether it will be more effective—and more true to itself—if agreements to act collectively at the UN are more frequent and, indeed, the norm.
	Does the Minister believe that there is a case for the European Union to be itself represented on a permanent basis in the Security Council? She shakes her head. In that case, because it is not a surprising response—it is a response shared by France for much the same reason—is it not an almost automatic consequence that Her Majesty's Government should consider supporting German membership of the Security Council on a permanent basis?
	Turning to the Doha round, the WTO trade negotiations, the role of the CAP in all this and prospects for the Hong Kong summit, the Government's response to the report's conclusions are admirable as far as they go, which I suggest is not quite far enough. Thus, in responding to the report's challenge in its summary at chapter 8, they state:
	"As EU Presidency, we will work closely with the Commission, our EU partners and other WTO members to build on the progress made so far to ensure a successful and pro-development outcome at the WTO Ministerial Conference in Hong Kong in December. This will allow us to achieve our aim of completing the WTO Round by the end of 2006. A successful trade round has the potential to lift 140 million people off subsidence of less than $2 a day . . . We will continue to press for reform of the CAP and other developed countries' trade-distorting agricultural policies".
	I imagine that that is to a considerable extent a reference to the policies of the United States. They go on to say:
	"Within the WTO Round, we will push for improved market access for developing countries, reductions in trade-distorting domestic support and agreement on an end date for agricultural export subsidies at Hong Kong".
	The trouble with those statements of good intent is, to go back to Sir Jeremy Greenstock's neat phrase, the decisions of political leaders in their national context: specifically, President Chirac being difficult and seeking to prevent Mr Mandelson from being good. There was President Chirac at Hampton Court declaring France's right not to approve any Doha outcome that undermines the 2003 CAP agreement: not 40 per cent cuts; no more than 25 per cent. The noble Lord, Lord Hannay, in this House on Monday, advised President Chirac—I certainly enjoyed this word of advice—to read the Nice treaty, because if he did so he would discover that he had no veto. However, we have a record of signing European treaties allegedly without having read them either.
	Before we all succumb to the pleasures of seeing Mr Mandelson as a righteous crusader—a slightly alarming prospect—let us try to remember that the countries of the developing world do not see even a 40 per cent cut as enabling them to surmount the hurdles facing their agricultural exports. The reason is simple: the Uruguay round set such high ceilings for United States and EU subsidies that insurmountable hurdles will remain even with a 40 per cent CAP cut. Will Her Majesty's Government recognise that and seek despite the difficulties with France and others to go beyond the rhetoric to the realities of what would actually make a difference to agricultural exports from the developing world?
	The Doha round started back in 2001, a journey that I hope will be completed in Hong Kong. But if it is really to alleviate the appalling disadvantages and problems faced by the developing world, a huge amount of work remains to be done. I would like to conclude with a brief example that is very topical. In 2001, the developing countries were promised special and differential treatment in the areas of public health and relevant intellectual property rights. The lack of clarification since 2001 in this area and in particular the failure to meet the deadlines that were accepted at that point of six months or slightly more means that we have reached a situation where, for example, if there was a flu pandemic in the developing world, countries in the developing world could, in theory, like ourselves or other countries in the developed world, overrule patent rights to manufacture the necessary drugs under compulsory licence, but only if they had the manufacturing capacity to do so.
	For example, a country such as Mozambique does not have such manufacturing capacity, so for it to issue a compulsory licence would be futile. It would need in some way to licence another country to act on its behalf as the manufacturer and at present it cannot do so. Will the Minister look at that issue urgently? The report asks the Government to use the remaining weeks of their presidency to make a difference at the United Nations and to advance the development agenda. I am sure that we all hope that that is indeed what will happen.

Lord Dykes: My Lords, I repeat and echo the thanks that have been paid to the chairman and members of the committee—on which I served as well, although I arrived on the scene later than some others—about the excellence of the report, its construction and the help given by our officials.
	This has been an excellent debate. I was particularly grateful for the very interesting organisational requirements for the UN enunciated by my noble friend Lady Falkner. That is a huge subject, which needs more discussion by experts in the future.
	I believe that the EU's role is improving in the UN. It is a considerable role already and needs to be much more cohesive and co-ordinated in the future. It is respected more in the UN because, unlike other leading members of the Security Council, it does not grind those more narrowly based axed. That is a genuine position, which can easily continue. I hope so. And there is no reason why the recent arrival of the 10 new members will change that position.
	The millennium summit was too ambitious in its coverage and suffered from the usual effect of looking much more interesting and compelling before it actually took place. I suppose that was inevitable. It was a long litany of desirable objectives and aspirations for a world where many countries are grappling with sincere and noble goals, including under-developed countries, where the danger is, as the Government have acknowledged, that implementation of reform measures is much harder than talking about them in such a large forum. The idea that all the millennium development goals will be reached in due time is a matter of doubt. On climate change, the crucial post-2012 obligations will, I hope, be dealt with decisively at the UN climate change conference in December, but there is an awful lot of work to be done, and talking, as we know, is easier than doing.
	Will the peacebuilding commission get off the ground eventually? There is room for serious doubt on that as well.
	I am glad that HMG have developed more arguments on conditionality which I believe have been put in the Library, or are about to be. We shall study those carefully.
	The DTI Minister, the noble Lord, Lord Sainsbury of Turville, spoke positively in answer to my Starred Question, on the urgency of the targets referred to by my noble friend Lord Watson for the Hong Kong conference at the end of the year.
	The EU response has already been much more helpful and rapid than that of the United States to many of these things. If the Prime Minister continues to claim a special relationship with an increasingly ailing President Bush, he should, in the time available in the second term, at least make sure that the Americans respond much more energetically than so far demonstrated.
	The Government have also recognised the need to analyse the conditions conducive to the spread of terrorism as well as the normal parts of the counter-terror strategy. That must include a coherent picture, description and recommendations about terrorism in uniform as well, whoever the perpetrators in different countries may be, in the future as in the past.
	Will we also be able to see progress in reform of the UN Security Council, so long overdue but still as elusive as ever, due the entrenched positions of the privileged elite of a small number of leading member states? It was rather depressing to read the press in the UK and elsewhere after the millennium summit, which was described as talking rather than achieving much. According to the Economist in mid-September:
	"Most countries put the blame on the United States, in the form of its abrasive new ambassador, John Bolton, for insisting at the end of August on hundreds of last-minute amendments and a line-by-line renegotiation of a text most others had thought was almost settled".
	According to the international section of the Guardian on 17 September, the only conclusion was "low marks on the final scoreboard". On the same date, the Guardian leader said:
	"Not much can be said in praise of the UN world summit, which has ended with little more than a heavily spun restatement of its loftiest ambitions".
	These are the realities we all face, which is why the Minister has to convince the House that action will be taken. The Independent said in its leading article on the same date:
	"Mr Blair has spent much of this past week attempting to chivvy the UN summit in New York into accepting a universal definition of terrorism. In this he has failed. The motion was rejected by the UN General Assembly".
	One can understand the reasons why.

Baroness Royall of Blaisdon: My Lords, I am grateful to all noble Lords who have contributed to this important debate on the European Union's role at the millennium review summit. I am also extremely grateful for the work of the noble Lords of Sub-Committee C, notably their excellent chair, the noble Lord, Lord Bowness, on their comprehensive report. As usual, it is of the highest standard.
	As this House will be aware, the Government and the European Union are deeply committed to the United Nations. Since the UN Secretary-General announced his intention to take forward his bold and ambitious reform agenda for the UN by setting up the High-Level Panel on Threats, Challenges and Change, of which the noble Lord, Lord Hannay of Chiswick, was a member, we have underlined at every opportunity our strong support for a more effective United Nations, better able to tackle the interrelated challenges of development, security and human rights, underpinned by an efficient UN Secretariat. That remains the case today.
	That is precisely why the Government and the European Union worked tirelessly for a successful outcome at the UN world summit in September. The reforms agreed, enshrined in the summit's so-called "outcome document", will set the agenda of the United Nations for years to come. They are a set of essential reforms and commitments that will enable the UN to be better equipped to tackle the challenges faced by the modern world. As the noble Lord, Lord Watson, suggested, this debate is an excellent opportunity to draw attention to the vital role of the EU within the United Nations.
	Holding the EU presidency, the UK plays an important role in the often difficult negotiations on the summit outcome document. Gaining consensus agreement on such a broad agenda was always going to be a difficult objective, reflecting the diversity of the UN's membership. But it is to the credit of the members of the United Nations, with the European Union at the fore, that they were able to rise to the challenge and agree on such an extensive set of reforms.
	The bar was set very high. The reports of the high-level panel, Jeffrey Sachs' UN Millennium Project, and Kofi Annan's own report In Larger Freedom demonstrated one inescapable truth: until the international community takes decisive action to address with urgency poverty, disease, environmental degradation and social injustice, we will not be to achieve sustainable conflict resolution and secure global peace and security. Without peace and security, we cannot tackle development—it is as simple as that. All of these are not possible without universal respect for human rights and the rule of law.
	History has shown that too often the international community has responded to these challenges with dissent and lethargy, driven by conflicting priorities. However, the summit has shown that the international community is at its most powerful and effective when it operates with unity and energy, driven by common goals and purpose. The summit secured firm commitments from both donor and developing countries on development, with several important Gleneagles outcomes endorsed and new EU commitments welcomed by the broader UN membership. These included the need to accelerate progress towards the millennium development goals and to address the special needs of Africa. As the noble Lord, Lord Astor, suggested, people say that it will be extremely difficult for us to reach the millennium development goals by 2015. However, that is what we shall strive to do. Those are our goals and we have to meet them, if at all possible. Together, I hope, we can do it.
	We certainly welcome the mandate given to the Secretary-General to address longer-term reform of the UN development architecture and we hope that this will result in more effective uses of the wealth of expertise, experience and resources within the UN system. We also support the clear commitment made to improving the timeliness and predictability of humanitarian funding. Humanitarian funding is one of the key plinths of our development policy, together with trade and the other part of the triangle.
	Sustainable development was recognised as a key element of the overarching framework of the UN's activities and was integrated throughout the development section of the outcome document, while the UN reform section underlined the need for a more coherent institutional framework for environmental activities in the UN system. Countries at the UN summit committed to move forward the global discussion on long-term co-operative action to address climate change and stressed the importance of the UN climate change conference to be held in Montreal later this month. Yesterday, the first meeting of the dialogue on climate change took place in London.
	At the EU Environment Council on 17 October, the EU agreed its negotiating strategy for the conference in Montreal. Its priority is to get the Kyoto Protocol off to a good start and to ensure that it operates efficiently. The EU confirmed its determination to meet its commitments under the UN Framework Convention and Protocol, including in relation to funding to assist developing countries. The EU also set an objective to launch discussions on a process to determine further action after the Kyoto Protocol's first commitment period.
	The summit's endorsement of the responsibility to protect underlined the obligation on states to protect their own populations from genocide, war crimes, ethnic cleansing and crimes against humanity. Importantly, for the first time, UN member states also acknowledged that the international community should act—through the Security Council—if governments fail to protect their populations from these terrible atrocities.
	The summit's agreement to create by the end of this year a new peacebuilding commission will close an institutional gap in the UN's conflict architecture and will assist countries emerging from conflict. As the holder of the EU presidency, we are working hard to achieve the establishment of the new body by 31 December of this year. There has been progress, including on arrangements for involving the affected countries in the work of the commission. Of course, there remains the need to find satisfactory conclusions on other practical issues, including on how the commission will operate. However, I understand that it is hoped that agreement will be reached in New York on countries being able to self-nominate. If that happens, clearly the peacebuilding commission could help countries to avoid slipping into conflict. The Government see an obvious need for a clear and agreed role for the United Nations Security Council in the peacebuilding commission, and this matter is currently under discussion.
	We have strongly welcomed the agreement to establish a new human rights council to replace the much-maligned Commission on Human Rights. Noble Lords are right when they say that the current commission is both inefficient and much discredited. But we are working hard with EU partners and the wider membership to settle the main elements of the council by the end of December so that the council can start its work as soon as possible in 2006. Human rights must have their proper place within the UN system, and that is right at the heart, or centre, of the UN system.
	I agree that preferably the human rights council should be smaller than the current commission. Obviously that is a very difficult matter for negotiation, but negotiations will continue. Consultations on the council have begun in earnest. The President of the General Assembly, Mr Eliasson, is holding four rounds of open consultation with states in October and November. He is aiming to produce a draft text in the second half of November and to begin detailed negotiations on 28 November with a view to reaching agreement on the main points by the end of the year. I consider that to be very good news for the global system of governance and human rights.
	In respect of terrorism, I was rather astounded to hear the quotation cited by the noble Lord, Lord Dykes, and to hear that he believed everything that he had read in the newspapers. I have participated with him in many debates on the European Union in which we have both urged noble Lords not to believe everything they read about the EU in the newspapers. I respectfully suggest to him that perhaps he should not believe everything that he reads about terrorism and the United Nations.
	Gaining an unequivocal condemnation of terrorism in all its forms and manifestations and, separately, unanimous adoption by the Security Council of the UK's Security Council resolution to prohibit by law incitement to terrorism were useful steps forward. Noble Lords will be glad to know that discussions on the comprehensive convention on international terrorism are ongoing, with the UK presidency participating actively. We welcome the commitment of world leaders at the summit to work to conclude this convention during the current session of the General Assembly, as the noble Lord, Lord Hannay, suggested.
	In response to the noble Baroness, Lady Falkner, about the OIC, the UK and other EU members have been lobbying the OIC on its proposed amendment to the comprehensive convention. The OIC proposal concerns foreign occupation and raises concerns with several delegations that an exception for the definition of terrorism is being sought, but the UK and other delegations are working hard to find a solution.
	Although the primary focus from the perspective of disarmament and non-proliferation this year was rightly the NPT review conference, its disappointing outcome gave us added incentive to make strenuous efforts to remedy that at the UN world summit in September. The Foreign Secretary was pleased to take part in the initiative promoted by his then Norwegian colleague designed to generate broad support for a forward-looking non-proliferation agenda. That is why, as presidency of the European Union, we also worked hard to secure European support for strong and meaningful commitments on non-proliferation and disarmament. From discussion with the new Foreign Minister of Norway last week, I understand that the initiative started by his colleague will continue. It is of course disappointing that the summit was unable to agree on commitments to disarmament and non-proliferation. However, we remain completely committed to exploring ways to achieve progress and to strengthen the global disarmament and non-proliferation regime.
	The IAEA general conference last month demonstrated an especially good spirit of co-operation and determination among states to strengthen non-proliferation and address other issues, such as the peaceful use of nuclear technology. Those are important building blocks. The UN First Committee, presently in session, the UNSCR 1540 Committee and the G8 global partnership are all fora in which we are actively participating and we continue to work hard to bring into force the Comprehensive Test Ban Treaty and to begin negotiations on a fissile material cut-off treaty.
	All those reforms were underpinned by proposals for reform of the UN Secretariat. The world summit recognised that the organisation needs reinvigorating to enable the UN to deliver the challenging mandate that it has been set. That will require an efficient and effective secretariat. Failure to reprioritise activity and modernise working methods risks undermining the wider reforms that the summit set in train.
	Some noble Lords have suggested that reform of the secretariat should be a secondary issue, but the Government's view is that reform of the secretariat is crucial to the implementation of the new UN agenda. We strongly endorse the reforms under way and urge the Secretary-General to be bold in the exercise of his existing mandate. Efforts already under way to strengthen accountability through improved oversight and performance management are welcome. Further reports from the Secretary-General are expected to make proposals for overhaul of financial and human resource regulations that will improve flexibility and transparency in decision-making at the UN. The EU will continue to work closely with the Secretary-General to deliver the management reforms that world leaders have endorsed.
	The lack of agreement that has been apparent for reform of the UN structure reflects the diverse and strong opinions within the UN system. The UK Government support reform of the UN Security Council, and its expansion to include Germany. We also support the extension of the Council to Japan, India and Brazil, as well as permanent African representation. My noble friend Lord Lea suggested that there are lessons to be learnt from past failures.